Roentgenologic Aspects of Reversible Vascular Occlusion of the Colon and Its Relationship to Ulcerative Colitis

Publisher Website
Google Scholar
Abstract
Reversible vascular occlusion of the colon is a roentgenologic and clinical entity. Clinical and experimental evidence indicate that its manifestions may subside without sequelae and unnecessary surgery may be avoided by prompt recognition. Vascular insults of the small and large bowel have received much attention in the recent literature (7, 9, 10, 12). It is our intention to demonstrate the roentgen features of reversible vascular occlusion of the colon and to suggest an anatomic explanation for these findings. Only one of the several cases we have seen, will be presented in detail because of the unique combination of clinical, radiologic, sigmoidoscopic, and anatomic proof it affords. The other cases have been reported elsewhere (4). Case Report A 75-year-old white male presented with a five-day history of passing small quantities of bright red blood per rectum. There were no other complaints. Physical examination was nonrevealing. Hemoglobin was 10.2 gm. on admission and remained stable. On sigmoidoscopy the day following admission numerous small, black, nodular masses projecting into the colon lumen were observed. During the course of the next fifteen days, 5 barium enema examinations were performed. The initial study (Fig. 1) revealed irritability and irregularity of the sigmoid. Marginal indentations or “thumbprints” were present. On the second examination, multiple small filling defects were encountered, but at the time of the final study the appearance of the colon had returned to normal (Figs. 2, 3). One of the nodules seen on sigmoidoscopy was proved by biopsy to be a nodular collection of submucosal hemorrhage due to infarction. Repeat sigmoidoscopy ten days after the first disclosed resolution of the nodules and an appearance of multiple superficial ulcers. Sigmoidoscopy was performed again five days later and revealed healing of the ulcers and slight mucosal granularity. Lumbar aortography demonstrated patency of the inferior mesenteric artery and its major branches to the colon. The patient was discharged in good condition and has remained well, without colon symptoms, for several months. Roentgen Features The single roentgen feature of note is nodulation. To this we, and others, have applied the terms “thumbprinting” and “pseudotumors.” Although these terms refer to the same pathologic change, in the presence of spasm the appearance is that of marginal thumbprinting (Fig. 1), while in the absence of spasm the aspect is that of circumscribed intramural or mucosal tumefactions (Figs. 4A and B; 5). The size of pseudotumors varies as does the depth of thumbprinting. Involvement has always been segmental without predilection for any portion of the colon. The nodulations have been transient and in all our cases the colon returned to roentgen normalcy in a relatively short period of time, save in one where operation was performed (Fig. 4).

This publication has 1 reference indexed in Scilit: